Homeless and Housing Resource contributing writer Livia Davis details the work of Downtown Emergency Service Center (DESC) in Seattle, Washington in implementing Alcohol Management as a harm reduction strategy and the need for research to determine if Alcohol Management results in better health outcomes, improved safety, and less victimization.

To limit potentially life-threatening effects of alcohol withdrawal, including seizures, hallucinations, falls resulting in head trauma or broken bones, and victimization due to acute intoxication, Downtown Emergency Service Center (DESC) in Seattle, Washington decided to implement Alcohol Management as a harm reduction strategy for eligible residents in their 1811 Eastlake supportive housing facility that serves “formally homeless men and women with chronic alcohol addiction.” Alcohol Management is offered to residents who are at risk of harm during periods of alcohol withdrawal or other dangerous behavior associated with their alcohol use. Not without controversy in the local community, DESC is committed to improving the quality of life for program participants, increasing their housing stability, and reducing the harm of alcohol withdrawal. Currently, about 16 out of 75 residents at 1811 participate in Alcohol Management indicating it's not an intervention best suited for everybody. At the Housing First Partners Conference in Chicago held on March 13, 2014, DESC explained how Alcohol Management works.

Using Motivational Interviewing, staff members first approach potential program candidates to facilitate the completion of a client’s alcohol intake goals. Questions are asked to develop an agreement for each participant, including: Do you drink more in the morning to stave off withdrawals? How many drinks do you need to avoid feeling sick? How long between drinks do you begin to go into withdrawal? What is your goal? Do you want to cut back? Based on responses, an individual alcohol management plan is developed and signed by the participant and DESC.

The plan details the dosage of alcohol to be administered by staff at certain intervals. For example, the plan may detail 2 beers at 8 a.m., 12 noon, 4 p.m., and 8 p.m. every day. At the agreed-upon times, the Alcohol Management participant then proceeds to the staff desk and is given the agreed-upon amount of beer.

To implement Alcohol Management, a number of processes and infrastructure and training need to be developed or be in place. Clients need to have a steady income source and a payee. Program funds are not used to purchase alcohol, and both the participant and their payee agree to provide needed funds according to the alcohol-purchasing schedule. Purchasing, storing, and dispensing alcohol dosages also require a number of processes and safeguards that 1811 Eastlake has developed over the last seven years, including locked cabinets, training of staff, and dosage tracking charts.

DESC collects anecdotal data on outcomes from the Alcohol Management program and reports the following:

Increases stability: The chaos of binging and withdrawing occurs less often and provides participants with a sense of stability and control they have not experienced in a long time. This increased stability is often associated with the development of new goals, including changing long standing drinking patterns;

Allows for intervention in case of alcohol withdrawal: With dosage tracking documentation sheets (e.g., if a participant misses his/her dosage for 24 hours) staff will go and check to be sure that the person is not experiencing harmful effects due to withdrawal;

Fosters engagement: Regular conversations can be maintained that increase awareness and stimulate articulation of goals, and allows for engagement around alcohol use to be a centerpiece of ongoing treatment planning;

Slows health decline: Alcohol management is not a magic bullet but getting less intoxicated means more engagement with health providers to address chronic and acute health need;

Likelihood of a decrease in alcohol use over time for some participants. While often not the inital goal, a number of residents participating in alcohol management have cut back or even stopped drinking altogether; and

Risk of loss of independence: Some participants get dependent on staff through structured alcohol dosage, and DESC recognizes that loss of independence is not necessarily a positive outcome, although has seen the same participants rediscover abilities to better integrate with community members or service providers through the stability afforded by participating in alcohol management.

DESC staff discussed the need for research to determine if Alcohol Management results in better health outcomes such as improved safety (e.g., fewer falls and reduction of instances of brain injury) and less victimization.

Sources for this article include: www.DESC.org and the Housing First Partnership Conference workshop on March 13, 2014: Alcohol Management: A Practical Harm Reduction Intervention conducted by Noah Fay and Hector Herrera from DESC.